Parent Child Interaction Therapy
John Paul Abner, Ph.D.
Milligan College
ETSU Center of Excellence for Children in State Custody
Copyright 2011, PCIT International
What is
Parent-Child Interaction Therapy?
PCIT
Parent-Child Interaction Therapy (PCIT)
 Empirically
supported
treatment for young
children (2.5 -7) with
disruptive behavior
 Developed by Dr.
Sheila Eyberg
© Gurwitch, Funderburk, & Nelson
Treatment Outcome Research and
Controlled Trials
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Significant reductions in noncompliance and
behavior problems
Generalization to home and school
Maintenance of gains up to six years after
treatment(maximum follow up time to date)
Generalization to untreated siblings
Changes in parents’ interactional style
© Gurwitch, Funderburk, & Nelson
How does PCIT work?
PCIT
Balances Two Factors…
1. Positive Interaction with the Child
Increase positive attention
Decrease negative attention
2. Consistent Limit Setting
Consistency
Predictability
Follow-Through
© Gurwitch, Funderburk, & Nelson
What makes PCIT unique among
parent training programs?
PCIT: Core Features
 Active
coaching of parent with their
child
 Grounded in developmental theory
 Emphasis on restructuring interaction
patterns
 Assessment-driven
 Not time-limited
 Empirically supported
COACHING
PCIT: Coaching

Allows therapist to:
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Better understand the parent-child
interaction
Change the interaction, not specific
behavior problems
Give parents specific and immediate
feedback on their use of the skills
 Correct errors immediately
 Praise appropriate behaviors
Assess readiness to move on to next
phase or graduate
PCIT: Coaching
Two-way
Mirror
Mom
Child
Bug-inthe-Ear
PCIT: Coaching
Two-way
Mirror
Coach
GROUNDED IN
DEVELOPMENTAL THEORY
Based on Developmental Theory

Nurturance and limits
both necessary for
healthy outcomes

PCIT draws from
attachment and social
learning theories to
achieve authoritative
parenting
NOT TIME-LIMITED
Not time-limited
•
•
Treatment continues until family meets
graduation criteria
Average 14-16 weeks, could be shorter or
longer
Completion = Success
ASSESSMENT DRIVEN
EMPIRICALLY
SUPPORTED
PCIT: A Model Program


Society of Clinical Child and Adolescent Psychology, APA
Division 53 (www.effectivechild therapy.com)
The National Child Traumatic Stress Network (SAMHSA,
2005; http://www.nctsn.org)

Chadwick Center for Children and Families
(http://www.chadwickcenter.org)
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National Crime Victims Research and Treatment Center
(U.S. Department of Justice; http://musc.edu/ncvc)


The California Evidence-Based Clearinghouse for Child
Welfare (2006; http://www.cebc4cw.org)
Youth Violence: A Report of the Surgeon General
(www.surgeongeneral.gov/library/youthviolence)
Efficacy of PCIT

Two well-conducted randomized trials
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Participants
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United Sates (Schuhmann et al., 1998)
Australia (Nixon et al., 2003)
Preschool age (3 to 6 years)
Disruptive behavior disorders
Primarily Caucasian
No significant developmental/cognitive delay
Improvements in (compared to waitlist)

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Child behavior
Parenting practices and stress
ECBI Intensity Scale
Efficacy of PCIT
p < .001
d = 1.40
(Schuhmann et al., 1998)
Cohen’s d
PCIT Effect Size
(Rosenthal et al., 1990)
(Connor et al., 2002)
(Schuhmann et al., 1998)
Efficacy of PCIT

Maintenance
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Short-term (1 to 2 years; Eyberg et al., 2001; Nixon et al., 2004)
Long-term (3 to 6 years; Boggs et al., 2004; Hood & Eyberg, 2003)
Generalization
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Siblings (Brestan et al., 1997; Eyberg & Robinson, 1982)
Preschool classrooms (Bagner et al., 2010; Funderburk et al.,
1998; McNeil et al., 1991)
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Meta-analytic work
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PCIT components associated with larger effect sizes
(e.g., active coaching, teaching parents positive interactions and
time out; Kaminski et al., 2008)

Comparable to Triple P (Thomas & Zimmer-Gembeck, 2007)
The PCIT Evidence Base: Randomized Controlled Trials
1998
Florida
Disruptive Behavior Disorders (DBD)
Schuhmann, Foote, Eyberg, Boggs, & Algina
2003
Australia
Disruptive Behavior Disorders
Nixon, Sweeney, Erickson, & Touyz
2004
Oklahoma
Physically Abusive Parents
Chaffin, Silovsky, Funderburk, et al.
2006
Puerto Rico
Attention Deficit Hyperactivity Disorder
Matos, Torres, Santiago et al.
2007
Florida
Comorbid Mental Retardation and DBD
Bagner & Eyberg
2010
San Diego
Mexican-American Children with DBD
McCabe & Yeh
2010
Rhode Island
2010
Oklahoma
Toddlers Born Premature with DBD
Bagner, Sheinkopf, Vohr, & Lester
Abusive and Neglectful Parents
Chaffin, Funderburk, et al.
Autism?
Copyright May 2008
Sheila Eyberg REV May
Relationship Enhancement:
Child Directed Interaction (CDI)
Goals of CDI
Enhance relationship between parent
and child
 Reduce frustration/anger
 Improve social skills
 Improve self-esteem
 Improve organization and attention
 Improve speech/language skills

© Gurwitch, Funderburk, & Nelson
MAIN RULE OF CDI:
LET THE CHILD LEAD THE PLAY
CDI: Features
 Special
Time
 The Do’s and Don’ts of Special
Time
 Tactical
Ignoring
 Coaching
to Criteria
© Gurwitch, Funderburk, & Nelson
CDI: Special Time
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Parents learn to set up a 5-minute “special
time” with their child in which they practice
the CDI skills to enhance their relationship
Therapists help parents problem solve:
 Time
 Place
 Toys to use
© Gurwitch, Funderburk, & Nelson
CDI: Don’t skills
 Lead
the play
 Give
commands
 Ask questions
 Criticize
© Gurwitch, Funderburk, & Nelson
CDI: Do skills
 Praise
 Reflect
 Imitate
 Describe
 Enjoy
© Gurwitch, Funderburk, & Nelson
CDI: Handling Misbehavior
 Ways
to handle
annoying, obnoxious
behavior during Special
Time
 Returning attention
when positive behavior
occurs
 Addressing aggressive
or destructive behavior
© Gurwitch, Funderburk, & Nelson
CDI: Mastery Criteria
 Determines
when family may be
ready to move on to the next phase
10 Labeled Praises
 10 Behavior Descriptions
 10 Reflections
 3 or fewer total of Commands,
Questions, & Critical statements

© Gurwitch, Funderburk, & Nelson
Discipline and Minding Skills:
Parent-Directed Interaction (PDI)
PDI: Features
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Giving good directions
Contingent consequences
Gradual generalization from clinic
minding exercises to “real life”
discipline
Planned responses to
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Refusal to stay in timeout
Impulsive, destructive, and dangerous
behaviors
Behavior disruptions in public settings
© Gurwitch, Funderburk, & Nelson
PDI: Time-Out
What is time-out
 Setting up time-out place
 How long
 Getting to time-out
 Staying in time-out
 Getting out of time-out
 Back-ups
 After time-out

© Gurwitch, Funderburk, & Nelson
PDI: Mastery Criteria
 At
least 75% of
commands given
are effective
commands
 At
least 75% correct
follow through
© Gurwitch, Funderburk, & Nelson
PCIT: Graduation Criteria
Caregivers’ CDI skills at mastery levels
 Caregivers’ PDI skills at mastery levels
 Child’s behavior rated as within ½
standard deviation of mean
 Caregivers report feeling comfortable
with using the skills

© Gurwitch, Funderburk, & Nelson
PCIT: Graduation
 Review
progress (use
summary sheet, ECBIs,
tapes, etc)
 Lots of praise
 Schedule booster or
follow-up as needed
 Managing future behavior
problems
© Gurwitch, Funderburk, & Nelson
QUESTIONS?